Provider Demographics
NPI:1609896877
Name:BISSELL, THOMAS A (DDS, DMSC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:BISSELL
Suffix:
Gender:M
Credentials:DDS, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHESTER WOODS PROFESSIONAL
Mailing Address - Street 2:385 STATE ROUTE 24 SUITE 3J
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930
Mailing Address - Country:US
Mailing Address - Phone:908-879-1830
Mailing Address - Fax:
Practice Address - Street 1:CHESTER WOODS PROFESSIONAL
Practice Address - Street 2:385 STATE ROUTE 24 SUITE 3J
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI199181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics